Medicare Rehab Coverage at All Points North
If you have Medicare, we’re here to help you understand your options, whether that means exploring other coverage or finding the right level of care.
If You Have Medicare, Here Are Your Options
If Medicare is your primary insurance, you still have options to consider.
Additional Insurance: Some people have secondary coverage through a job, retirement plan, or spouse. If your plan includes PPO benefits, you may be eligible for care at APN. We can check your coverage for you quickly.
Medicare Advantage: If you have a Medicare advantage plan, check if it covers out-of-network care. Some of these plans function like PPOs, depending on their details.
Self-Pay: If you’re considering paying privately, we’ll review costs and financial options with clarity and confidentiality.
Referrals: If APN is not financially feasible, we can help connect you with treatment providers who accept Medicare. You do not have to navigate this alone.
Contact our admissions team today.
Request a confidential consultation. Verify insurance. Explore payment options with APN
You’re welcome to contact us anytime to discuss your situation. We'll provide clear information and help you understand your options moving forward.
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Free Resources for Medicare Beneficiaries Seeking Rehab
| Resource | Detail |
|---|---|
| Medicare.gov | Official Medicare website. Search for Medicare-covered treatment facilities and learn about your benefits. |
| 1-800-MEDICARE | 1-800-633-4227 is a free 24/7 helpline for all Medicare questions, including rehab coverage. |
| SAMHSA National Helpline | 1-800-662-HELP (4357) is a free, confidential, 24/7 treatment referral. |
| findtreatment.gov | Search for addiction treatment by location, insurance type, and service. |
| State Insurance Counseling (SHIP) | Free State Health Insurance Assistance Program. |
| 988 Crisis Line | Dial 988 for immediate mental health crisis support, 24/7. |
Understanding Medicare Coverage for Rehab
Medicare is a federal health insurance program primarily for adults 65 and older, as well as certain younger individuals with disabilities or End-Stage Renal Disease.
Medicare is divided into several parts, and coverage for substance use and mental health treatment varies by plan.
| Medicare Part | Rehab Coverage Overview |
|---|---|
| Part A (Hospital Insurance) | Covers inpatient hospital stays, including detox and inpatient psychiatric care. Coverage limited to 190 days for psychiatric hospital care in a lifetime. Skilled nursing facility care limited. |
| Part B (Medical Insurance) | Covers outpatient mental health services, individual and group therapy, and outpatient substance use treatment. 20% coinsurance after annual deductible. |
| Part C (Medicare Advantage) | Private insurance alternative to traditional Medicare. Coverage for rehab varies by plan. Some Medicare Advantage plans cover more than traditional Medicare. |
| Part D (Prescription Drug) | Covers prescription medications, including MAT drugs like buprenorphine and naltrexone. Covered drugs vary by plan. |
| Medigap (Supplement) | Supplements traditional Medicare by covering copays, coinsurance, and deductibles. Does not expand on which services are covered. |
Medicare has specific rules about what it covers. Services must be considered medically necessary and fit within certain levels of care.
Key Limitations of Medicare Rehab Coverage
Even at Medicare-accepting facilities, there are important limitations to be aware of:
| Limitation | Detail |
|---|---|
| Inpatient Days Cap | Medicare Part A covers hospital stays with significant cost-sharing after 60 days; the stay is otherwise limited to full coverage. |
| Psychiatric Facility Lifetime Limit | Medicare limits psychiatric hospital inpatient days to 190 in a lifetime. This is a significant constraint for serious conditions. |
| Prior Authorization | Many services require prior authorization through Medicare Advantage plans. Traditional Medicare requirements vary. |
| Medically Necessary Only | Medicare only covers services deemed medically necessary. Holistic, wellness, and many integrative modalities are not covered. |
| Coverage Gaps | The Medicare Part A deductible ($1,632 per benefit period in 2024) can be a substantial out-of-pocket cost. |
| Limited Luxury Amenities | Medicare does not cover luxury accommodations, private rooms, spa services, or integrative wellness that are the standard at All Points North. |
Why All Points North Does Not Accept Medicare
Medicare sets payment rates at the federal level using standard models of care that don’t align with our approach at APN. We focus on an individualized, whole-person approach, offering lower client-to-staff ratios, integrated mental health and addiction care, and advanced clinical services.
Medicare’s current reimbursement structure does not support this level of care. Rather than compromise our clinical standards, we’ve chosen to maintain our clinical model and help patients find other ways to access treatment.
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Frequently Asked Questions
Does Medicare cover addiction or mental health treatment at all?
Yes. Medicare typically covers certain inpatient and outpatient behavioral health services, including therapy and hospital-based care, as long as the treatment meets medical necessity criteria.
Why can’t I use my Medicare benefits at APN?
APN is not a Medicare-approved provider, which means Medicare does not reimburse for services received here. This is based on how Medicare structures and approves participating facilities.
What if I have Medicare and secondary insurance?
It’s a good idea to check your secondary or supplemental insurance. If it includes PPO or out-of-network benefits, you may be able to access treatment at APN. We can confirm your coverage details for you.
Are Medicare Advantage plans different from regular Medicare?
Yes. Medicare Advantage (Part C) plans are run by private insurers and may include different networks or benefit structures. Some plans offer more flexibility, depending on how they’re designed.
Will I have to pay everything out of pocket if I come to APN?
If Medicare is your only coverage, treatment at APN would typically be self-pay. If you have additional coverage, we’ll review it to see what may apply before you make any decisions.
Should I still call if I’m not sure what my options are?
Yes. You don’t need to have everything figured out first. We’ll help you understand your coverage, explore alternatives, and identify the most realistic next steps.
Contact All Points North
You’re welcome to contact us anytime to discuss your situation. We'll provide clear information and help you understand your options moving forward.